Classification The classification of Parkinson's disease is made on the age of the first symptoms manifestations:
- Juvenile (children’s age);
- Early (young to middle age);
- Late (advanced age).
It can be also further classified by the character of the symptoms into:
However, the classification data of Parkinson's disease and Parkinson's syndrome are not considered to be flawless. Therefore, today there is no generally accepted approach to this issue.
Etiology and pathogenesis of the disease
Contemporary medicine has reached a certain progress in the understanding of the molecular and biochemical mechanisms of the disease. Nevertheless, the true etiology of the sporadic (unusual) forms of this disease is still unknown. It is considered that genetic predisposition and environmental factors are of great importance. The combination of these two factors initiates the generative process in the pigment-carrying and later all other neurons of the brain stem. Once starting to develop, the process becomes unstoppable and irreversible and starts its expansion throughout the whole brain.
The major effect is rendered on the protein substances of the nervous system and particularly alpha-synuclein. On the cell level, this mechanism looks like an insufficiency of breathing function of mitochondria and the oxidative stress. However, it is still believed that the pathogenesis of the disease is also driven by other factors which are still undiscovered. Nevertheless, currently, the medications that allow helping people with the disease diminish the symptoms exist. At our med store, you can buy antiparkinsonian drugs that are considered the most efficient and harmless to date at the low prices because we offer the less advertised generic versions of them
Clinical manifestations of Parkinson’s disease
The main signs that can make an individual or a medical professional suspect Parkinson’s disease are:
- Tremor (shaking);
- Muscle rigidity (stiffness);
- Hypokinesia (decreased range of motion);
- Postural regulation disorder.
The most typical manifestation is the resting tremor but there could be also other types of tremor, for instance, postural tremor or intentional tremor.
The muscle rigidity can be slightly noticeable at the early stages of the tremulous form of Parkinson's disease but pronounced in fully developed disease. The major importance has the identification of minimal asymmetry of the tone in the extremities as it is one of the characteristic features of all Parkinson’s disease stages.
Hypokinesia (decreased range of motion) is an obligatory condition for the diagnosis of Parkinson’s disease but it can be hard to detect it at the early stages. For this, the demonstrative examination methods are used, for instance, a doctor can ask a patient to quickly clench and unclench the fist. The manifestations of these symptoms can be also noted in shaving, tooth brushing, buttoning of small buttons, and so on. The signs that need attention are the slow motions, a decrease of motions, and decreased amplitude of motion. The doctors call it an impairment of the individual body language as the common gestures, mimics, speech and plasticity of motility is violated.
The postural disturbances start to manifest quite early. For instance, there can be an asymmetry in the outstretched arms. Nevertheless, they attract the attention of doctors at a disadaptative stage (III stage). It is explained by the fact that the postural changes are less typical compared to the other Parkinson’s disease symptoms.
Besides the listed main symptoms, supplementary ones that can be the most pronounced are also observed. For instance, it can be drooling, dysarthria and/or dysphagia, constipation, dementia, depression, sleep disorders, dysuria (inability to urinate), restless leg syndrome, and others.
Based on the severity of the symptoms, a patient is attributed a stage of the disease from 0 to 5 where 0 doesn’t have motion disturbances and 5 is when a patient cannot move or even stand up without the help of a caregiver.
The diagnosis is made in three steps:
1. The identification of the Parkinson’s syndrome and its differentiation from other neurological and psychopathological syndromes which are somehow similar to true parkinsonism. True parkinsonism is typically identified when hypokinesia (lowered range of motion) is accompanied by one of the following symptoms: resting tremor, muscle rigidity, postural instability not related to the primary vestibular, visual and cerebellar disorders.
2. The stage includes the exclusion of other diseases that can manifest alike parkinsonism such as:
- Oculogic crises;
- Use of neuroleptics prior to the onset of the symptoms manifestation;
- History of multiple strokes;
- Brain injuries;
- Brain tumor;
- Irresponsiveness to the therapy of Levodopa and others.
3. The third stage includes the identification of symptoms confirming Parkinson's disease based on at least three of the following criteria:
- Unilateral manifestations at the start of the disease;
- Presence of tremor in rest;
- Asymmetry of the symptoms;
- 70-100% of the reaction to Levodopa therapy;
- Progression of the disease;
- The long-lasting symptoms of the disease which are present for more than 10 years.
The tests that are implemented to diagnose the patients with the symptoms include rheoencephalography, EEG, neuroimaging such as CT of the brain and MRI.
Before you buy an antiparkinsonian drug, you need to be 100% sure that it is Parkinson’s disease and not the disease accompanied by the parkinsonism syndrome such as secondary parkinsonism, pseudoparkinsonism, etc. Around 80% of the cases of parkinsonism manifestation are eventually diagnosed as Parkinson’s disease. The doctors should pay special attention to the peculiarities that can cause the doubts in the diagnosis of the disease such as ineffectiveness of Levodopa, lack of tremor, the symmetry of the motion disturbances, and others.
Treatment of Parkinson’s disease
The therapy of the disease substantially differs for the early and late stages of the disease. The therapy of the early stages is made with the aim of the sufficient regress of the impaired function with the use of the minimum possible medication dosages. It presumes the use of the medications that increase the dopamine synthesis in the brain, medicines that stimulate its release, and those that prevent its reuptake, suppress dopamine decay, stimulate dopamine receptors and inhibit neuronal death.
For instance, a doctor can appoint the therapy with amantadine, selective MAO-B inhibitors (selegiline, etc.), dopamine receptor agonists (piribedil, pramipexole, etc.). It is possible to combine these medications but more frequently a single formulation is used.
The above-listed formulations are significantly less potent than Levodopa but for the therapy at the early stages they are sufficient. The aim of such medications is to delay the start of the therapy with Levodopa or lower its dosages at the late stages.
There are no precise criteria for the optimal time of Levodopa-based formulations start of use. Usually, doctors chose the medication also based on the age of the patient. It is preferable to appoint Levodopa at the age of 60 and above because over time the therapy with it becomes less and less effective and the disease progresses faster.
Besides the antiparkinsonian drugs, the individuals with this diagnosis are advised to undergo psychotherapy and possibly take medications for their mental health as with the progression of the disease the development of depression, fear, and anxiety are common.
Antiparkinsonian medications you can buy at 4RXStore
We strive to offer our clients the best deals, i.e. the most qualitative generics of the modern and effective medicines at the cheapest prices. Our range of products continuously expands and not we have the following medications in this section:
- Generic Sinemet made based on Carbidopa and Levodopa is a medication used preferably at the late stages of the disease development. It is based on two active substances: Levodopa is responsible for the antiparkinsonian effect while Carbidopa is added to minimize the amount of dopamine in the peripheral tissues where it occurs but doesn’t render a positive effect and is responsible for the major adverse effects because of which Levodopa’s big dosages are undesirable.
- Generic Trivastal based on Piribedil and manufactured by Serdia Pharmaceuticals is a medication used not only for Parkinson’s disease but also cognitive function deterioration with age, intermittent claudication, and ischemic eye diseases. The medication is a piperazine derivative that acts as a D2 and D2 receptor agonist, i.e. the stimulator of dopamine receptors. It is recommended to use it for the therapy of the early stages before Levodopa.
Please keep in mind that this article is for information only. You must not make a self-diagnosis and buy antiparkinsonian drugs without your doctor’s instructions even though you can order them from our med store without Rx.